News & Updates

In cooperation with the American Ambulance Associationwe and others have created a running compilation of local and national news stories relating to EMS delivery, powered by EMSIntel.org. Since January 2021, 2,678 news reports have been chronicled, with 42% highlighting the EMS staffing crisis, and 38% highlighting the funding crisis. Combined reports of staffing and/or funding account for 79.5% of the media reports! 201 reports cite EMS system closures/takeovers, or agencies departing communities, and 94% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals Protected.xlsx

  • 27 Nov 2024 10:20 AM | Matt Zavadsky (Administrator)

    While it is not often that we get excited about an OIG opinion, this one is significant because the CMS OIG referenced the clinical and fiscal benefits associated with TIP!

    From the Opinion:

    Nevertheless, for the following reasons, we believe the risk of fraud and abuse presented by the Proposed Arrangement is sufficiently low under the Federal anti-kickback statute for OIG to issue a favorable advisory opinion, and, for the following reasons and in an exercise of our discretion, we would not impose sanctions under the Beneficiary Inducements CMP.

    Third, even when a Federal health care program pays for the TIP services furnished under the Proposed Arrangement, the Proposed Arrangement appears unlikely to increase costs to Federal health care programs and may ensure an appropriate level of care for patients to whom Requestor furnishes EMS services in response to a 911 call. More specifically, TIP services may be a viable option, in certain circumstances, to improve quality of care and avoid unnecessary transports to hospital emergency departments. Consequently, TIP services have the potential to lower costs for Federal health care programs while also delivering timely, appropriate, and medically necessary care to patients on-site who do not also require transportation to a hospital.

    --------------------------

    The Office of Inspector General (OIG) just issued a favorable Advisory Opinion to a municipal EMS Agency regarding its proposal to bill patients’ insurance plans—and waive any patient cost-sharing amounts—for treatment-in-place (TIP) services provided to patients who are not transported.  

    While the OIG has already issued favorable opinions and a regulatory safe harbor (42 CFR § 1001.952(k)(4)) concerning cost-sharing waivers for emergency ambulance transports, this is the first time the OIG has addressed cost-sharing waivers related to non-transport services. 

    Key Takeaways

    Medicare Part B does not currently cover TIP services.  However, Advisory Opinion 24-09 indicates that the OIG is favorable to cost-sharing waivers related to TIP services that are covered by state Medicaid programs and Medicare Advantage plans. Moreover, the OIG seems to indicate that if Medicare Part B covered TIP services in the future, cost-sharing waivers would be permitted under the conditions outlined in the Opinion. 

    The OIG emphasizes the advantages of TIP services, stating:

    “[T]o the extent the Proposed Arrangement avoids an ambulance transport or subsequent hospital care, [it] could reduce costs to Federal health care programs overall, thereby mitigating the risk of inappropriately increased costs to Federal health care programs. Further, the TIP services furnished by Requestor under the Proposed Arrangement may result in patients receiving care more quickly and efficiently and at a more appropriate level of care . . . More specifically, TIP services may be a viable option, in certain circumstances, to improve quality of care and avoid unnecessary transports to hospital emergency departments. Consequently, TIP services have the potential to lower costs for Federal health care programs while also delivering timely, appropriate, and medically necessary care to patients on-site who do not also require transportation to a hospital.”

    Note: Agencies must separately consider any implications of cost-sharing waivers for TIP services concerning non-Federal healthcare payers. There may be limitations under state law or a contract with a private healthcare payer. Finally, while indicative of the OIG’s stance on this practice, like all OIG advisory opinions, Advisory Opinion 24-09 cannot be relied upon by any other agency, and agencies are encouraged to obtain expert advice concerning their specific situation when considering cost-sharing waivers.   

    More About the Opinions and Circumstances

    The county-based ambulance service proposed implementing a charge for TIP services furnished in connection with 911 responses - limited to emergency responses only (i.e., only responses that meet the definition of “emergency response” at 42 CFR § 414.605). Their charge for TIP services would be based on the level of care furnished to the patient and would not exceed amounts currently submitted for payment for the same level of care furnished in connection with an ambulance transport. The charge would be imposed regardless of the patient’s health insurance (e.g., regardless of whether the patient is enrolled in commercial insurance or a Federal healthcare program), whenever it provides an emergency response and furnishes care to a patient at the scene but does not transport the patient by ambulance. The ambulance service proposed accepting any health insurance payment (including Federal healthcare programs) for TIP services as payment in full and not billing patients for any cost-sharing amounts (e.g., copayments)  associated with covered TIP services. This waiver would apply to both County residents and nonresidents and be applied uniformly to all patients who receive TIP services. 

     

    The OIG cited the following reasons why it believes the risk of fraud and abuse is “sufficiently low” under the Federal anti-kickback statute (AKS) and why the OIG would be favorable to the Proposed Arrangement:

     

    1. Uniformity of Waiver.  The ambulance service would uniformly apply its cost-sharing waiver policy for all individuals who receive TIP services in connection with an emergency response regardless of payor.
    2. Minimal Implication to Federal Payers. The OIG noted that neither Medicare Part B nor the State Medicaid program in the ambulance service’s state currently covers TIP services.  Only a handful of Medicare Advantage plans and certain Medicaid programs in states adjacent to the service’s home state currently cover TIP services. Thus, in most circumstances, the Proposed Arrangement would result in no costs to Federal healthcare programs. 
    3. No Increased Costs. Citing TIP's benefits, the OIG stated that the Proposed Arrangement was unlikely to increase costs to Federal health care programs and may ensure an appropriate level of patient care. 


  • 27 Nov 2024 6:28 AM | Matt Zavadsky (Administrator)

    Continuing examples of the EMS staffing crisis across the U.S.

    Issues like this continues to beg the question about the logic of shutting down ambulances due to lack of a paramedic as opposed to staffing the ambulances with EMTs, especially when, according to national, evidence-based research, the vast majority EMS patient can be effectively treated by EMTs, without the need for ALS personnel.

    A recent national webinar with EMS physicians, innovative agency chiefs, and public policy officials, along with a summary of this research can be found here: https://aimhi.mobi/ondemand/13420011

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    Staffing issues leave Pepperell fire station empty for one night

    By Louisa Moller

    November 25, 2024

    https://www.cbsnews.com/amp/boston/news/staffing-pepperell-fire-station-empty-one-night/

    PEPPERELL - Staffing issues at the Pepperell Fire Department came to a head Sunday night, when the fire station was completely empty after 5 p.m.

    "Due to staffing issues, there is no Ambulance for Pepperell we will be relying on other towns for coverage. There isn't a single person working tonight at your fire station," Pepperell Firefighters IAFF Local 5018 wrote in Facebook post.

    Out of its eight full-time positions, Pepperell fire has only three filled right now. Two full time staff left over the summer and another person is on medical leave.

    "I just couldn't fill it. I'm worried about running our career staff into the ground in mental health and a long with the demands of the job," fire Chief Brian Borneman told WBZ-TV.

    Staffing issues are plaguing emergency services statewide as multiple departments compete for a smaller pool of applicants. Borneman says Pepperell covers the shortages by using on call and per diem staff or mutual aid from other towns.

    "And we're kind of the smaller fish in the sea. So, we're competing with the bigger places all the time for that same talent pool," Borneman said.

    The chief finds himself in a tough position. Even when he finds job candidates, each paramedic requires two years of training before they can start.

    "If your next question is, 'what's the answer,' I don't have a good answer. I don't know what that is," he said.

    Hospital closure compounds the problem 

    The closure of Nashoba Valley Medical Center in Ayer has compounded the problem. While Borneman says Pepperell can transport its patients to another hospital in Nashua, New Hampshire in almost the same amount of time, the closure is causing transport delays in other towns which assist Pepperell with mutual aid.

    "What I really worry about is how we're so interdependent. That's across the state. All of our towns, we support them, they support us. And when their transport times become more significant or wall times at a hospital, it starts having this ripple effect across the state," he said.

  • 27 Nov 2024 6:26 AM | Matt Zavadsky (Administrator)

    This is outstanding news for the EMS profession!

    View the full bill below:
    https://www.congress.gov/bill/118th-congress/senate-bill/5400

    There are currently 12 bills in Congress that are very beneficial to EMS providers, agencies, and the communities we serve. 

    Please take an active role in national advocacy organizations to help get these initiatives through the legislative process!

    Current EMS Economic Legislation

    Manchin, Collins Introduce Bipartisan Improving Access to Emergency Medical Services Act

    https://www.manchin.senate.gov/newsroom/press-releases/manchin-collins-introduce-bipartisan-improving-access-to-emergency-medical-services-act 

    Washington, DC – This week, U.S. Senators Joe Manchin (I-WV) and Susan Collins (R-ME) introduced the Improving Access to Emergency Medical Services (EMS) Act. This bipartisan legislation would create a pilot program to allow Medicare to reimburse for treat-in-place EMS services for certain medical issues, which would expand access to these critical health services, especially in rural communities, while reducing unnecessary emergency room visits and expenses.

    “I’m proud to introduce the bipartisan Improving Access to Emergency Medical Services (EMS) Act with Senator Collins to advance the treat-in-place model in West Virginia, Maine and throughout the country,” Senator Manchin. “This model is essential for ensuring Americans, especially in rural communities, can receive the care they need without unnecessary and expensive emergency room visits. I encourage my colleagues on both sides of the aisle to support this important effort that cuts costs and bolsters access to quality, affordable health services for our constituents.”

    “Having access to high-quality emergency medical services is essential for individuals in rural communities across Maine and the nation,” said Senator Collins. “This bipartisan bill would expand the treat-in-place model for EMS services, reducing unnecessary emergency room visits, lowering costs, and easing the strain on our state’s hospital and EMS workforces.”

    The bill would allow seniors on Medicare to receive at-home emergency medical services to treat minor medical incidents. In West Virginia, patients on state insurance can receive care from EMS providers for diabetes evaluation, asthma/COPD evaluation, and seizure evaluation at the scene of the call without having to transport patients to the hospital. In addition to the services provided by EMS, part of the protocol would be to advise the patient to follow-up with their primary care provider to ensure continuity of care.

    Representatives Mike Carey (R-OH), Lloyd Doggett (D-TX), Carol Miller (R-WV) and Debbie Dingell (D-MI) introduced companion legislation in the House, where it has the support of the National Rural Health Association, International Association of Fire Chiefs, International Association of Firefighters, American Ambulance Association, Congressional Fire Service Institute, National Association of Towns and Townships and the National Association of Emergency Medical Technicians.

    Last year, Senator Manchin led the West Virginia delegation in urging the Centers for Medicare & Medicaid Services (CMS) Administrator to consider the treat-in-place model to address the workforce challenges faced by West Virginia hospitals and EMS providers.



  • 17 Nov 2024 10:02 PM | Matt Zavadsky (Administrator)

    Earlier this year, the Academy of International Mobile Healthcare Integration (AIMHI) released our bi-annual 2024 Benchmark Report. While that report covered high-level metrics, respondents supplied a plethora of valuable, granular detail regarding operational and financial metrics.

    We are releasing this BONUS EDITION of the Benchmark Report, detailing the Financial Metrics achieved by these High-Performance/High Value (HP/HV) EMS systems.

    We encourage public policy officials and EMS system leaders to compare their performance metrics with these systems.

    If you would like any assistance developing your metrics, please feel free to contact us at hello@aimhi.mobi

    Key Takeaways from this Report include:

    • 59.7% of emergency services provided by participating AIMHI agencies were billed at the ALS-Emergency level, and 36.1% were billed at the BLS-Emergency level.
    • The average expense per transport for participating AIMHI agencies was $532.47. The average expense per capita was $72.88.
    • Among participating AIMHI agencies, the Average Patient Charge (APC) was $1,343.12, with a low of $740.00 and a high of $1,969.52.
    • Among participating AIMHI agencies, the average reimbursement per transport was $427.58. Average patient self-pay reimbursement was $53.47, average Medicaid reimbursement was $228.09, average Medicare reimbursement was $435.94 and average commercial insurance reimbursement was $859.43. On average, Medicare Advantage reimbursement was $50 less than Fee for Service Medicare.
    • Commercially insured patients represented 16.2% of the patients served, but 32.9% of the patient services revenue received.


    Click the link below to view and download the full BONUS EDITION: Financial KPIs Report:

    2024 High Performance-High Value EMS Delivery KPIs - Financial.pdf

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    Our desire in releasing these performance metrics is to assist local policy makers and EMS leaders evaluate their EMS system’s performance, balanced with the needs and desires of the community the system serves.

    These are examples of financial KPIs for some of America’s highest performing EMS systems.

    No two systems are alike, and variables such as cost of service delivery, payer mix, average patient charge and revenue cycle management procedures could impact the economic sustainability of the local EMS agency.






  • 11 Nov 2024 3:47 PM | Matt Zavadsky (Administrator)

    Earlier this year, the Academy of International Mobile Healthcare Integration (AIMHI) released our bi-annual 2024 Benchmark Report. While that report covered high-level metrics, respondents supplied a plethora of valuable, granular detail regarding operational and financial metrics.

    We are releasing this BONUS EDITION of the Benchmark Report, detailing the Operational Metrics achieved by these High-Performance/High Value (HP/HV) EMS systems.

    We encourage public policy officials and EMS system leaders to compare their performance metrics with these systems.

    If you would like any assistance developing your metrics, please feel free to contact us at hello@aimhi.mobi

    Key Takeaways from this Report include:

    The per-Capita response rate for participating AIMHI member agencies was 0.18961, meaning a ‘typical’ 100,000 population community would generate 18,961 EMS responses.

    To meet this response demand, participating AIMHI agencies scheduled an average of 0.37305 unit hours per Capita, meaning an average of 37,305 ambulance unit hours per 100,000 population, or the equivalent of 4.3 ambulances per 100,000 people.

    Response Unit Hour Utilization (UHU-R) for AIMHI agencies participating in the survey was 0.508, essentially meaning on average, an on-duty ambulance was assigned to a response 50.8% of the time they were on-duty.

    Respondents reported achieving an average of 90.1% scheduling efficiency, meaning they were able to provide 90.1% of the planned unit hours.

    Click the link below to view and download the full BONUS EDITION: Operational KPIs Report:

    2024 High Performance-High Value EMS Delivery KPIs - Operational - FINAL.pdf

    ------------------------

    Our desire in releasing these performance metrics is to assist local policy makers and EMS leaders evaluate their EMS system’s performance, balanced with the needs and desires of the community the system serves.

    These are examples of operational KPIs for some of America’s highest performing EMS systems.

    No two systems are alike, and variables such as how long it takes to complete an EMS response due to factors such as travel distances, hospital delays and desired response times could impact the resources needed to effectively serve the community.


  • 5 Nov 2024 12:25 PM | Matt Zavadsky (Administrator)

    The results would be exceptionally valuable information for the industry!

    Announcing the National EMS Documentation Survey

    PWW|AG is excited to announce the National EMS Documentation Survey, which will identify attitudes, challenges, and issues inherent in documenting EMS patient interactions. EMS leaders have consistently identified high quality clinical and operational documentation as one of their organizations' most vexing and persistent challenges.

    The National EMS Documentation Survey may be completed by any individual with a role in EMS, including EMS practitioners, medical directors, EMS leaders, managers and executives, EMS billing and revenue cycle management professionals, and others. The Survey will measure critical issues such as:

    • EMS provider and leadership attitudes toward patient care report (PCR) documentation;
    • Comfort with and ease of use of EMS PCR technology;
    • Sufficiency of time allocated to PCR documentation;
    • Need for training and education on EMS documentation issues;

    The Survey takes an estimated 10-15 minutes to complete. The results will help provide insight and research into improving EMS patient care reporting documentation and will help provide the tools and support that EMS professionals need to produce high-quality documentation.
    To access the Survey, visit:

    https://www.surveymonkey.com/r/EMSDocumentationSurvey or use the QR code below.
     


  • 4 Nov 2024 5:47 AM | Matt Zavadsky (Administrator)

    Outstanding guidance from this recently released Consensus Statement of the National Association of EMS Physicians International Association of Fire Chiefs and the International Association of Chiefs of Police on best practices for collaboration between law enforcement and emergency medical services during acute behavioral emergencies.

    Two of the principal authors of the National Consensus Statement, Drs. Kupas and Miller, will be presenting an overview of the paper at the upcoming EMS Law and Policy Symposium on Medical Civil Rights in Emergency Services.  The Symposium will be held this Thursday, November 7th, at the Widener University Commonwealth Law School in Harrisburg, PA. 

    Symposium registration is free, and the program will be available remotely via Zoom. 

    In addition to a discussion of the new Consensus Statement, the Symposium will also include attorneys from the litigation team on the Elijah McClain case in Colorado, and representatives of the Harvard-affiliated Medical Civil Rights Initiative. For more information and to register, visit:

    https://commonwealthlaw.widener.edu/current-students/law-school/events/detail/3516/

    ------------------------------------ 

    Consensus Statement of the National Association of EMS Physicians International Association of Fire Chiefs and the International Association of Chiefs of Police: Best Practices for Collaboration Between Law Enforcement and Emergency Medical Services During Acute Behavioral Emergencies

    https://pubmed.ncbi.nlm.nih.gov/39264840/

    There must be an awareness of the potential for bias such as anchoring bias, ascertainment bias, and confirmation bias. We must make a conscious effort at an independent assessment of the individual. The goal is to optimize the individual’s safety with the minimal use of force or restraint, yet still provide for the safety of first responders and bystanders.

    Medical Evaluation

    The potentially competing priorities of LE and EMS also need to be recognized and addressed as part of conjoint education and training to ensure collaboration in the assessment and any required clinical treatment of these individuals.

    Optimally, LE should give a short, objective summary to EMS on the circumstances of the encounter. This summary should include the reason for the encounter, pertinent observed behaviors, medical history that may have been volunteered by the individual or bystanders, descriptions of any use of force and/or the use of less lethal weapons that may have been employed, as well as any other potential sources of trauma.

    Emergency medical services must have access to the patient for clinical assessment, which may require transition from LE positioning and restraints to medical positioning and restraints. Law enforcement may provide input on the threat posed by transitions so that the team can collaborate to arrive at the safest solution that allows for the provision of any needed clinical care.

    Foremost is the need to identify and treat a potentially life-threatening medical condition, including, but not limited to, hypoxia, hypoglycemia, metabolic derangements, hyperthermia, cardiac conditions, and trauma. The EMS clinicians must also be cognizant of possible toxidromes as a potential cause of the patient’s behavior, which may require immediate treatment.

    Restraints and Patient Positioning

    A decision to utilize pharmacologic management shall be made solely by EMS based upon their independent patient assessment and in strict accordance with EMS protocols and medical director oversight.

    Transport

    In some cases, LE may choose to transport the individual either to a medical facility or directly to a facility for legal remand. In these situations, it is important – when indicated – that EMS be utilized as a resource in these decisions. Although EMS clinicians may be asked by LE to evaluate an individual prior to transport to a detention facility, they should not provide a medical “clearance” without a complete clinical assessment.

    Some of these individuals require advanced medical assessment and interventions not available to EMS. In situations when EMS is transporting, LE and EMS should ensure there are sufficient personnel with the appropriate scope of practice to address medical contingencies and continue any required physical restraint during transport. The monitoring and care in this setting should be delineated by EMS agency protocols and policies.


  • 1 Nov 2024 10:27 AM | Matt Zavadsky (Administrator)

    An interesting and growing trend as the EMS economics crisis presses on.
     
    Agencies and communities that subsidize EMS now billing neighboring communities for mutual aid, especially jurisdictions who are not providing public funding, and as such, have difficulty with EMS responses.
     
    The public policy argument is that a community paying for EMS delivery should not have the resources they are funding responding outside their community to provide primary EMS response to neighboring communities whose systems are unable to response, due to lack of funding.
     
    A survey on EMS Economics published by NAEMT in 2023 revealed the cost trends in mutual by some agencies.

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    Rapho supervisors OK solicitor to defend against invoice from MESA
    ROCHELLE A. SHENK
    Oct 29, 2024
     
    https://lancasteronline.com/news/regional/rapho-supervisors-ok-solicitor-to-defend-against-invoice-from-mesa/
     
    When: Rapho supervisors meeting, Oct. 17.
     
    What happened: Supervisors authorized the township’s solicitor, Susan Peipher of Apple, Yost & Zee, to defend against efforts by Municipal Emergency Services Authority to collect charges against the township for medical services provided to township residents.
     
    Cost: The township received a $6,200 invoice from MESA for services rendered to residents in September.
     
    Background: MESA was formed in an attempt to create a fiscally sustainable model for providing emergency medical services in the region Northwest EMS formerly served. Northwest EMS had been the township’s emergency medical services provider; however, supervisors voted against joining MESA. Since January, Rapho’s emergency medical services provider has been Penn State Health Life Lion.
     
    Township discussion: Township Manager Randall Wenger said he had discussed MESA’s invoice with Lori Shenk, the township’s emergency management coordinator. Shenk, who is also a first responder and had served as Northwest EMS community outreach manager, said she had concerns with the township paying the invoice without discussing it with the solicitor. She said she felt it could set a precedent.
     
    Quotable: In an Oct. 18 email Shenk said, “To the best of my knowledge/understanding, Rapho Township does not have a contract or agreement with MESA and I do not know municipal law or the laws pertaining to the authority, therefore I believe it’s prudent for the township to have their solicitor determine if there is an obligation to pay any invoices from MESA.”
     
    MESA viewpoint: Justin Risser, MESA treasurer and Conoy Township supervisor, said in an Oct. 18 phone call that Rapho is one of four municipalities served by Penn State Health Life Lion to receive an invoice for mutual aid service for September. Risser said mutual aid represents about 10% of MESA’s calls, and residents in the municipalities that are part of MESA are paying for it. Mutual aid occurs when a municipality’s emergency service provider is unable to provide service and another provider is called.
     
    More: Risser said MESA noticed an issue with mutual aid calls to cover for Life Lion since the beginning of the year, but they’ve increased over time. The residents in the four municipalities that were invoiced also will receive an invoice for the difference between what their insurance pays and the cost for the specific service, Risser said. With the four municipalities, he said MESA is trying to cover a shortfall in the payment for the cost of service.
     
    Quotable: “We want to help out (by providing mutual aid), but it’s not fair to our residents (who) are paying a fee for our services,” he said. “The intent of these invoices to municipalities is to encourage them to have a conversation with their provider. Their provider (Life Lion) is not being truthful with the municipalities about their coverage rate.”

  • 30 Oct 2024 2:44 PM | Matt Zavadsky (Administrator)

    As the period for Medicare Ground Ambulance Data Collection System (GADCS) submissions starts to wind down, the Academy of International Mobile Healthcare Integration (AIMHI) is interested in doing a cost and revenue analysis, using data submitted to Medicare, in advance of Medicare finalizing their assessment. We believe this advance assessment will serve two key purposes for the industry:

    • Provide valuable information to the EMS profession about costs and revenues for service delivery that can be used to advocate for reimbursement changes.
    • Provide a 'gut check' on what the data shows so that when Medicare does release their analysis, the industry will have some 'ground truth' on pre-assessment of the same data submitted to Medicare.

    We commit to releasing an only aggregated data, without any agency identifiers. However, for additional assurance, agencies can either 'stamp' their PDF with 'Confidential', or include 'confidential' in the file name.

    The secure link to upload the PDF files is: https://pwwemslaw.sharefile.com/i/i97ecb1d33dc479d9

    Thank you!
    Chip Decker, President

    Below are the instructions for the secure file upload. If you have any questions, or would like support setting this up, feel free to contact Matt Zavadsky at Matt.Zavadsky@pwwadvisorygroup.com, or by phone/text at 817-991-4487.
    -----------------------
    Click on the link below: https://pwwemslaw.sharefile.com/i/i97ecb1d33dc479d9 You'll be prompted to set up a login:

    Once created, you'll be prompted confirm your email and create a password - once completed, you'll be navigated to the link to upload your GADCS file.



  • 21 Oct 2024 9:08 PM | Matt Zavadsky (Administrator)

    CMS Transmittal: 12896

    https://www.cms.gov/files/document/r12896cp.pdf 

    Full transmittal here: 2025 CMS AFS AIF Memo.pdf


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